Tuesday, June 25, 2013
Op report #7
Right Hip Open Removal of Hardware, Bursectomy and Gluteus Medius Repair Indications: the patient had a prior surgical dislocation, painful hardware and loose medius and adductor weakness. She had a failed non- operative management and indicated for removal of hardware and Bursectomy and gluteus medius repair. Procedure: The patient was correctly identified in the holding area, she was brought to the operating room. Spinal anesthesia was administered she was placed in the lateral decubitus position and the right leg was prepped and draped in the standard, sterile, fashion. Approximately 4cm incision was made over the previous lateral incision from the Gibson approach and taken down to the level of the iliotibial band. Scar tissue was debrided. The iliotibial band was split using modified anterior Gibson approach in line with the fibers of the gluteus Maximus. There was significant bursal inflammation on the undersurface of the iliotibial band which was excised and resected en mass. Three 2.5 mm screws were identified and extracted. The abductor tendons were intact although there was some attenuation of the posterior superior facet, insertion of the round fibers of the gluteus medius. Using drill tunnels through the posterior, superior facet, modified Mason- Allen sutures using #1 OrthoCord sutures were used to restore tension on the abductor in this region. The PRP was then injected at the site of the abductor repair. The wound was copiously irrigated. A light closure was performed with 0 vicryl for the iliotibial band and 0 vicryl 1 and 2.0 Vicryl for the deep layer and a 3.0 Monocryl sutures with Steri Strips. The wounds were cleaned, dried and sterile dressings were applied.